title: Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery.
abstract: OBJECTIVE
  To describe the change in ventilatory practice in a tertiary paediatric intensive care unit (PICU) in the 5-year period after the introduction of high-flow nasal prong (HFNP) therapy in infants <24 months of age. Additionally, to identify the patient subgroups on HFNP requiring escalation of therapy to either other non-invasive or invasive ventilation, and to identify any adverse events associated with HFNP therapy.
  
  
  METHODS
  The study was a retrospective chart review of infants <24 months of age admitted to our PICU for HFNP therapy. Data was also extracted from both the local database and the Australian New Zealand paediatric intensive care (ANZPIC) registry for all infants admitted with bronchiolitis.
  
  
  RESULTS
  Between January 2005 and December 2009, a total of 298 infants <24 months of age received HFNP therapy. Overall, 36 infants (12%) required escalation to invasive ventilation. In the subgroup with a primary diagnosis of viral bronchiolitis (n = 167, 56%), only 6 (4%) required escalation to invasive ventilation. The rate of intubation in infants with viral bronchiolitis reduced from 37% to 7% over the observation period corresponding with an increase in the use of HFNP therapy. No adverse events were identified with the use of HFNP therapy.
  
  
  CONCLUSIONS
  HFNP therapy has dramatically changed ventilatory practice in infants <24 months of age in our institution, and appears to reduce the need for intubation in infants with viral bronchiolitis.
authors.affiliation: Paediatric Critical Care Research Group, Mater Health Services, South Brisbane, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Schibler
authors.forename: T M T
authors.initials: TM
authors.lastname: Pham
authors.forename: K R
authors.initials: KR
authors.lastname: Dunster
authors.forename: K
authors.initials: K
authors.lastname: Foster
authors.forename: A
authors.initials: A
authors.lastname: Barlow
authors.forename: K
authors.initials: K
authors.lastname: Gibbons
authors.forename: J L
authors.initials: JL
authors.lastname: Hough
mesh_terms: D001988:Bronchiolitis / Q000503:physiopathology; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D007441:Intubation, Gastrointestinal / Q000706:statistics & numerical data*; D008297:Male; D008485:Medical Audit; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D012189:Retrospective Studies